The adequacy of lymph node harvest in concomitant neck block dissection and submental island flap reconstruction for oral squamous cell carcinoma; a case series from a single Egyptian institution

Abstract

BackgroundSquamous cell carcinoma (SCC) is a fairly common tumor of the oral cavity. This tumor may affect any part of the mucosa of the oral cavity especially the tongue, the floor of the mouth and lips. The encountered intra-oral defects after tumor resection are often large and require climbing up the reconstruction ladder to more complex reconstructive options for accepted functional and cosmetic results to be achieved. However, most of the patients are old with medical co-morbidities requiring fast, simple, less morbid reconstructive option such as local flaps. The myocutaneous submental island flap has emerged as a simple and fast reconstructive technique that provides thin, pliable tissue with adequate volume and reliable blood supply. However, one major concern regarding the utility of the submental flap for repair of post-ablative tumor defects is the presumed interference with adequate lymph node neck dissection.MethodsIn this study, we present a cohort of thirty-six consecutive patients who were operated for oral SCC. All patients were offered submental island flap reconstruction of their resultant defects together with ipsilateral selective neck block dissection of levels I, II, III and IV; and the nodal yield of each level was tested pathologically.ResultsNodal harvest was ≥12 in 88 % of the patients. Complications were encountered in two patients (5.5 %).ConclusionOur data suggest that adequate cervical lymph nodes dissection, specifically level I and II cervical lymph nodes, can be fulfilled with concomitant submental island flap elevation.

Submental artery island flap with simultaneous level I neck dissection

“…More recently, the flap was been used for oral cavity and oropharyngeal mucosal defects. The oncologic safety and adequacy of lymph node dissection has been demonstrated by multiple groups . The oncologic safety is less of a concern in the management of oropharyngeal, laryngeal, and hypopharyngeal compared with oral cavity tumors.…”

Submental Artery Island Flap in Oral Cavity Reconstruction. An Observational, Retrospective Two-centre Study

“…It has also been used for malar augmentation with fascia flap only, 29,32 reconstruction of defects with hair-bearing skin, 33 tongue and/or floor of mouth defects, buccal mucosa defects, palatal defects, 34 nasal reconstruction, 35 lip reconstruction, [36][37][38] cervical esophagus repair or reconstruction, [39][40][41] hemilaryngectomy defects repair, 31 reconstruction of the neopharynx after total laryngectomy, repair of pharyngocutaneous fistulas 42 and coverage of hardware used in spine surgery. 43 There is controversy in the literature about the oncological safety of the SAIF due to the relationship between the flap and lymph nodes of the Ib region, because these nodal levels might be involved even at an early stage of OSCC, 44,45 and this can increase the risk of recurrence, 44,46,47 as well as hindering a rigorous cervical level I neck dissection.…”

Reconstruction of total parotidectomy defects with a de‐epithelialized submental flap

“…For the primary parotid cancer, level 1A nodal disease is an atypical presentation, as compared to oral cavity. In the case of oral cavity tumors, several studies have demonstrated safety with using the submental flap . In 50 patients with oral cavity malignancies undergoing submental flap reconstruction, Howard et al demonstrated occult nodal disease in level 1A in 10% of patients, without compromise to the patient's cancer care in using this flap .…”